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Rich, Joanne NEW YORK STATE DEPARTMENT OF HEALTH `. " u Burial �13 Vital Records Section - Transit Permit Name First Middle Last Sex Joanne Marie Rich Female Date of Death Age If Veteran of U.S. Armed Forces, July 18, 2014 78 War or Dates }'"' Place of Death Hospital, Institution or uj City, Town or Village Albany Street Address 0' Manner of Death❑ Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending 0 Circumstances Investigation W Medical Certifier Name Title fl Arc,' G' i/i 6! 6 4 5 pi n Addr.. 6/ '�n-5 --& ,zi y /,7/39 Death Certificate Filed -- Istria Number Register Number City, Town or Village 5-76 a A.3 0 Burial Date Cemetery or Crematory July 21, 2014 Pine View Crematorium ❑Entombment Address - ®Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address _._ Hold CO Date Point of 0 0 Transportation Shipment _ by Common Destination CI Carrier Date Cemetery Address El Disinterment ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 v_ Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom t Remains are Shipped, If Other than Above 2: Address IX 0' Permission is hereby granted to dispose of the human remain described above as indicated. Date Issued 7-Ji ,Zv/Y Registrar of Vital Statistics n 5 W . ._L_7 w ` (signature) District Number 76 Q Place j e . F-' I certify that the remains of the decedent identifie above were disposed of in accordance with this permit on: uj Date of Disposition 07/21/2014 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W new grave CO © (section) ��1!//(lot number) (grave number) a;' Name of Sexton or Person in Charge of remises G�,r,rt blur. , e.ia t (p/ ase print) Signature Title GeEmajNt (over) DOH-1555 (02/2004)